Editor—Commendably, Owen et al are committed to reducing inappropriate intravenous antibiotic prescribing but we are concerned by some of their assumptions.1 Although the guidelines from the British Thoracic Society state that patients with a CURB-65 score of 0 or 1 are likely to be suitable for home treatment, Hoare and Lim have recognised that clinical judgment is also needed.2 Similarly, recent guidance from the Department of Health and Health Protection Agency on the management of Panton-Valentine leukocidin associated staphylococcal pneumonia has stated that CURB-65 may be misleadingly low in fit young adults.3 In a study in our own institution over the last year (in preparation) five of 40 patients with a CURB-65 score of 1 at presentation required care in a high dependency unit or intensive care unit.
We would be concerned if blind adherence to a score designed for mortality prognostication without reference to the current or deteriorating physiological state of the patient resulted in patients being managed inappropriately, and we believe that if CURB-65 is used then decision making should also allow for the inclusion of clinical judgment as suggested by Hoare and Lim.
Competing interests: None declared.
References
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